Trinity University of Asia

St. Luke’s College of Nursing

CARDIOVASCULAR SYSTEM
Anatomy and Physiology

I. Functions of the Heart

a. Generating blood pressure
b. Routing blood
c. Ensuring one-way blood flow.
d. Regulating blood supply.

II. Anatomy of the Heart

 The heart is a hollow muscular organ enclosed in a protective sac, divided into four chambers.
 Layers of the heart
o Epicardium
 Fibrous outside protective layer
 Epicardium = Protective Layer = Outermost
o Myocardium
 Middle layer of specialized cardiac muscle
 Layer that contracts
 Myocardium = Muscle layer = Middle
o Endocardium
 Endothelial lining of the chambers
 Endocardium = Endothelium = “En” side layer
 Pericardium
o Protective sac encasing the heart
o Anchors the heart within the mediastinum
o Two layers:
 Fibrous pericardium
 Tough, fibrous connective tissue outer layer
 Serous pericardium
 Inner layer of flat epithelial cells, with a thin layer of connective tissue
 Parietal pericardium
o Portion lining the fibrous pericardium
 Visceral pericardium
o Portion covering the heart
 Chambers of the Heart
o Receiving chambers
 Right atrium
 Receives deoxygenated blood from the superior vena cava, inferior vena
cava, coronary sinus
 Left atrium
 Receives oxygenated blood from the pulmonary vein
o Discharging chambers
 Right ventricle
 Pumps deoxygenated blood to the lungs
 Left ventricle
 Pumps oxygenated blood to systemic circulation
o Septum
 The septum that divides the heart longitudinally is referred to as either the
interventricular septum or the interatrial septum, depending on which chamber it
separates.
 Valves of the Heart
o Atrioventricular (AV) Valves
 Separate and control the blood flow between the atria from the ventricles
 Tricuspid valve
 Between the RA and RV
 Has three flaps
 Mitral valve
 Between LA and LV
 Has two flaps
 Chordae Tendinae
 Connects the flaps of the AV valves to the papillary muscles to prevent
backflow
 S1, the first heart sound (“lub”), is heard when the AV valves close.
o Semilunar Valves
 Separate the cardiac chambers from the great vessels and control blood flow out of
the cardiac chambers
 Pulmonic valve
 Between RV and PA
 Unoxygenated blood flows though this valve to the lungs
 Aortic valve
 Between LV and Aorta
 Oxygenated blood is pumped from the heart through this valve into systemic
circulation
 S2, the second heart sound (“dub”), is heard when the SL valves close.
 Associated Great Vessels
o Superior Vena Cava and Inferior Vena Cava
 The heart receives relatively deoxygenated blood from the veins of the body through
the large superior and inferior vena cava and pumps it through the pulmonary trunk.
o Pulmonary Arteries
 The pulmonary trunk splits into the right and left pulmonary arteries, which carry
blood to the lungs, where oxygen is picked up and carbon dioxide is unloaded.
o Pulmonary Vein
 Oxygenated blood drains from the lungs and is returned to the left side of the heart
through the four pulmonary veins.
o Aorta
 Blood returned to the left side of the heart is pumped out of the heart into the aorta
from which the systemic arteries branch to supply essentially all body tissues.
 Cardiac Circulation
o Coronary Arteries
 The coronary arteries branch from the base of the aorta and encircle the heart in the
coronary sulcus (atrioventricular groove) at the junction of the atria and ventricles,
and these arteries are compressed when the ventricles are contracting and fill when
the heart is relaxed.
 Left Main Coronary Artery (LMCA)
 Supplies blood to the left side of the heart muscle (the left ventricle and left
atrium)
 Divides into 2 branches:
o Left Anterior Descending Coronary Artery (LADCA)
 Supplies blood to the front of the left side of the heart.
o Circumflex Coronary Artery (CCA)
 Encircles the heart muscle.
 Supplies blood to the outer side and back of the heart.
 Right Coronary Artery (RCA)
  Supplies blood to the right ventricle, the right atrium, and the SA (sinoatrial)
and AV (atrioventricular) nodes, which regulate the heart rhythm.
 Together with the left anterior descending artery, the right coronary artery
helps supply blood to the middle or septum of the heart.
o Coronary Veins
 The myocardium is drained by several cardiac veins, which empty into an enlarged
vessel on the posterior of the heart called the coronary sinus.
 Blood Vessels
o Blood circulates inside the blood vessels, which form a closed transport system, the so-called
vascular system.
o Arteries.
 As the heart beats, blood is propelled into large arteries leaving the heart.
o Arterioles.
 It then moves into successively smaller and smaller arteries and then into arterioles,
which feed the capillary beds in the tissues.
o Veins.
 Capillary beds are drained by venules, which in turn empty into veins that finally
empty into the great veins entering the heart.
 Tunics
o Except for the microscopic capillaries, the walls of the blood vessels have three coats or
tunics.
o Tunica intima.
 The tunica intima, which lines the lumen, or interior, of the vessels, is a thin layer of
endothelium resting on a basement membrane and decreases friction as blood flows
through the vessel lumen.
o Tunica media.
 The tunica media is the bulky middle coat which mostly consists of smooth muscle
and elastic fibers that constrict or dilate, making the blood pressure increase or
decrease.
o Tunica externa.
 The tunica externa is the outermost tunic composed largely of fibrous connective
tissue, and its function is basically to support and protect the vessels.
 Major Arteries of the Systemic Circulation
o Arterial Branches of the Ascending Aorta
 The aorta springs upward from the left ventricle of heart as the ascending aorta.
 Coronary arteries.
 The only branches of the ascending aorta are the right and left coronary
arteries, which serve the heart.
o Arterial Branches of the Aortic Arch
 The aorta arches to the left as the aortic arch.
 Brachiocephalic trunk.
 The brachiocephalic trunk, the first branch off the aortic arch, splits into the
right common carotid artery and right subclavian artery.
 Left common carotid artery.
 The left common carotid artery is the second branch off the aortic arch and it
divides, forming the left internal carotid, which serves the brain, and the left
external carotid, which serves the skin and muscles of the head and neck.
 Left subclavian artery.
 The third branch of the aortic arch, the left subclavian artery, gives off an
important branch- the vertebral artery, which serves part of the brain.
 Axillary artery.
 In the axilla, the subclavian artery becomes the axillary artery.
 Brachial artery.
  The subclavian artery continues into the arm as the brachial artery, which
supplies the arm.
 Radial and ulnar arteries.
 At the elbow, the brachial artery splits to form the radial and ulnar arteries,
which serve the forearm.
o Arterial Branches of the Thoracic Arch
 The aorta plunges downward through the thorax, following the spine as the thoracic
aorta.
 Intercostal arteries.
 Ten pairs of intercostal arteries supply the muscles of the thorax wall.
o Arterial Branches of the Abdominal Aorta
 Finally, the aorta passes through the diaphragm into the abdominopelvic cavity,
where it becomes the abdominal aorta.
 Celiac trunk.
 The celiac trunk is the first branch of the abdominal aorta and has three
branches: the left gastric artery supplies the stomach; the splenic artery
supplies the spleen, and the common hepatic artery supplies the liver.
 Superior mesenteric artery.
 The unpaired superior mesenteric artery supplies most of the small intestine
and the first half of the large intestine or colon.
 Renal arteries.
 The renal arteries serve the kidneys.
 Gonadal arteries.
 The gonadal arteries supply the gonads, and they are called ovarian arteries
in females while in males they are testicular arteries.
 Lumbar arteries.
 The lumbar arteries are several pairs of arteries serving the heavy muscles
of the abdomen and trunk walls.
 Inferior mesenteric artery.
 The inferior mesenteric artery is a small, unpaired artery supplying the
second half of the large intestine.
 Common iliac arteries.
 The common iliac arteries are the final branches of the abdominal aorta.
 Major Veins of the Systemic Circulation
o Veins Draining into the Superior Vena Cava
 Veins draining into the superior vena cava are named in a distal-to-proximal direction;
that is, in the same direction the blood flows into the superior vena cava.
 Radial and ulnar veins.
 The radial and ulnar veins are deep veins draining the forearm; they unite to
form the deep brachial vein, which drains the arm and empties into the
axillary vein in the axillary region.
 Cephalic vein.
 The cephalic vein provides for the superficial drainage of the lateral aspect of
the arm and empties into the axillary vein.
 Basilic vein.
 The basilic vein is a superficial vein that drains the medial aspect of the arm
and empties into the brachial vein proximally.
 Median cubital vein.
 The basilic and cephalic veins are joined at the anterior aspect of the elbow
by the median cubital vein, often chosen as the site for blood removal for the
purpose of blood testing.
 Subclavian vein.
  The subclavian vein receives venous blood from the arm through the axillary
vein and from the skin and muscles of the head through the external jugular
vein.
 Vertebral vein.
 The vertebral vein drains the posterior part of the head.
 Internal jugular vein.
 The internal jugular vein drains the dural sinuses of the brain.
 Brachiocephalic veins.
 The right and left brachiocephalic veins are large veins that receive venous
drainage from the subclavian, vertebral, and internal jugular veins on their
respective sides.
 Azygos vein.
 The azygos vein is a single vein that drains the thorax and enters the
superior vena cava just before it joins the heart.

o Veins Draining into the Inferior Vena Cava

 The inferior vena cava, which is much longer than the superior vena cava, returns
blood to the heart from all body regions below the diaphragm.
 Tibial veins.
 The anterior and posterior tibial veins and the fibular vein drain the leg;
the posterior tibial veins becomes the popliteal vein at the knee and then
the femoral vein in the thigh; the femoral vein becomes the external iliac
vein as it enters the pelvis.
 Great saphenous veins.
 The great saphenous veins are the longest veins in the body; they begin at
the dorsal venous arch in the foot and travel up the medial aspect of the leg
to empty into the femoral vein in the thigh.
 Common iliac vein.
 Each common iliac vein is formed by the union of the external iliac vein and
the internal iliac vein which drains the pelvis.
 Gonadal vein.
 The right gonadal vein drains the right ovary in females and the right testicles
in males; the left gonadal veins empties into the left renal veins superiorly.
 Renal veins.
 The right and left renal veins drain the kidneys.
 Hepatic portal vein.
 The hepatic portal vein is a single vein that drains the digestive tract organs
and carries this blood through the liver before it enters the systemic
circulation.
 Hepatic veins.
 The hepatic veins drain the liver.

III. Physiology of the Heart

 Intrinsic Conduction System
o Series of pathways that conduct electrical impulses through the heart, stimulate
depolarization and resulting muscle contraction of the chambers in a specific sequence, and
initiate the pumping action of the heart.
o This conduction takes place because of the special electrophysiologic properties of the
specialized cells in the conduction system.
 Automaticity
 Ability to initiate an electrical impulse
 Excitability
 The ability of a cell to respond to stimulus
  Conductivity
 The ability to transmit impulses from one cell to another.
 Contractility
 The ability to contract after an electrical impulse is received.
 Rhythmicity
 The cell's ability to send electrical impulses in a regularly and evenly paced
manner.
 Refractoriness
 The cell's inability to respond to another electrical impulse.
o The components of the cardiac conduction system are as follows:
 Sinoatrial (SA) Node:
 Natural pacemaker.
 Concentration of cells responsible for initiating the conduction impulse in the
healthy heart.
 Located in the right atrium at juncture with SVC
 Rate 60 – 100 beats per minute
 Internodal pathways
 Carry impulse from SA node to AV node through both right and left atria
 Impulse initiates process of depolarization in both atria
 Depolarization results in myocardial contraction of both atria.
 Atrioventricular (AV) Node
 Located at the base of the atrial septum
 Slows the impulse
 Allows atria to fully empty before initiating depolarization of ventricles
 When SA node is not functioning, can initiate an impulse at the rate of 40-60
beats per minute
 Bundle of His
 Short branch of conductive cells connecting the AV node to the bundle
branches at the intraventricular septum
 Bundle Branches
 Right bundle branches (RBB) and Left bundle branches split off on either
side of intraventricular septum
 Carry impulse to Purkinje Fibers
 Purkinje Fibers
 Diffuse network of conduction pathways
 Terminal branches of the conduction system
 Conduct impulses rapidly throughout the ventricles
 Initiate rapid depolarization wave throughout the myocardium and resulting
ventricular contraction
 When the SA and AV nodes fail, initiate impulses at the rate of 20-40 beats
per minute.
 Cardiac Cycle
o Each cardiac cycle is one complete heartbeat
o Includes two parts:
 Systole:
 Portion of the cardiac cycle when ventricles DEPOLARIZE and CONTRACT
to pump blood into pulmonary and systemic circulation
 Begins with closure of the AV Valves
 Ends with closure of the SL valves
 Diastole
 Portion of the cardiac cycle when the ventricles REPOLARIZE and refill with
blood
 Begins with closure of the SL valves
  Ends with closure of the AV valves
 Atrial systole (Depolarization and contraction) is part of the late ventricular diastole
and atrial diastole occurs during ventricular systole.
o Process:
1. The atria and ventricles are relaxed. AV valves open, and blood flows into the
ventricles. The ventricles fill to approximately 70% of their volume.
2. The atria contract and complete ventricular filling.
3. Contraction of the ventricles cause pressure in the ventricles to increase. Almost
immediately, the AV valves close (the first heart sound “lub”). The pressure in the
ventricles continues to increase.
4. Continued ventricular contraction causes the pressure in the pulmonary trunk and
aorta. As a result, the SL valves are forced open, and blood is ejected into the
pulmonary trunk and aorta.
5. At the beginning of ventricular diastole, the ventricles relax, and the SL valves close
(the second heart sound “dub”).
 Ventricular systole occurs between the first and second heart sounds.
 Ventricular diastole occurs between the second heart sound and the first heart sound
of the next beat.
 Aortic pressure curve:
 Contraction of the ventricles forces blood into the aorta
o The maximum pressure in the aorta is the systolic pressure
 Elastic recoil of the aorta maintains pressure in the aorta and produces the
dicrotic notch
 Blood pressure in the aorta falls as blood flows out of the aorta
o The minimum pressure in the aorta is the diastolic pressure
o Electrocardiogram
 Action potentials conducted through the heart during the cardiac cycle produce
electrical currents that can be measured at the surface of the body.
 P wave
 Corresponds to depolarization of the atria (SA node)
 QRS complex
 Corresponds to ventricular depolarization
 T wave
 Corresponds to ventricular repolarization
o Cardiac Output
 Volume of blood pumped by either ventricle of the heart each minute.
 Indicator of pump function of the heart
 CO (mL/min) = Stroke Volume (mL/beat) x Heart Rate (beats/min)
 Heart Rate
 Number of complete cardiac cycles per minute
 Stroke Volume
 Volume of blood ejected from the left ventricle each cardiac cycle.
 SV and CO are influenced by preload, afterload and contractility.
 Preload
o Degree of myocardial fiber stretch at the end of ventricular diastole.
o Influenced by ventricular filling volume and myocardial compliance.
 Afterload
o Resistance that the ventricles must overcome to eject blood into the
systemic circulation.
o Directly related to arterial blood pressure.
 Contractility
o Strength of contraction regardless of preload
 o Decreased by hypoxia and some drugs (BB, CCB), increased by
some drugs (Digoxin, Dopamine)
o Mean Arterial Blood Pressure
 Average blood pressure in the aorta
 Adequate blood pressure is necessary to ensure delivery of blood to the tissues
 Proportional to CARDIAC OUTPUT (amount of blood pumped by the heart per
minute) times PERIPHERAL RESISTANCE (total resistance to blood flow through
blood vessels)
 CO X PR
 Venous return is the amount of blood returning to the heart
 Increased venous return increases stroke volume by increasing end-diastolic
volume
 Increased force of contraction increases stroke volume by decreasing end-
systolic volume
 Intrinsic Regulation Of The Heart
o Modifies stroke volume through the functional characteristics of cardiac muscle cells
o Starling’s law of the heart describes the relationship between preload and the stroke
volume of the heart
o An increased preload causes the cardiac muscle fibers to contract with a greater force and
produce a greater stroke volume
o Afterload is the pressure against which the ventricles must pump blood.
 Extrinsic Regulation of the Heart
o Modifies heart rate and stroke volume through nervous and hormonal mechanisms
 The cardioregulatory center in the medulla oblongata regulates the parasympathetic
and sympathetic nervous control of the heart
 Epinephrine and norepinephrine are released into the blood from the adrenal medulla
as a result of sympathetic stimulation. They increase the rate and force of heart
contraction
o ANS: regulates cardiac function and blood pressure; balance exists between sympathetic and
parasympathetic branches.
 Parasympathetic stimulation is supplied by the vagus nerve
 Decreases heart rate.
 Postganglionic neurons secrete acetylcholine, which increases membrane
permeability to K. Hyperpolarization of the plasma membrane increases the
duration of the prepotential
 Sympathetic stimulation is supplied by the cardiac nerves
 Increases heart rate and the force of contraction (stroke volume)
 Postganglionic neurons secrete norepinephrine, which increases membrane
permeability to Ca2+. Depolarization of the plasma membrane decreases the
duration of the prepotential
o Changes in sympathetic and parasympathetic activit occur in response to sensory receptors
in the body, chemoreceptors, baroreceptors, and stretch receptors.
 Chemoreceptors:
 Located in the aortic arch and carotid bodies; sense chemical changes in the
blood, primarily hypoxia and to a lesser degree hypercapnia
 Respond by inducing vasoconstriction.
 Baroreceptors:
 Provide a rapid response to changes in pressure
 Sensation of low pressure initiates sympathetic stimulation resulting in:
o Increased heart rate
o Vasoconstriction
o Increased blood pressure
 Sensation of increased pressure sends impulses to medulla
 o Decreased heart rate
o Decreased blood pressure.
 Blood Circulation Throughout the Heart
o Entrance to the heart.
 Blood enters the heart through two large veins, the inferior and superior vena cava,
emptying oxygen-poor blood from the body into the right atrium of the heart.
o Atrial contraction.
 As the atrium contracts, blood flows from the right atrium to the right ventricle through
the open tricuspid valve.
o Closure of the tricuspid valve.
 When the ventricle is full, the tricuspid valve shuts to prevent blood from flowing
backward into the atria while the ventricle contracts.
o Ventricle contraction.
 As the ventricle contracts, blood leaves the heart through the pulmonic valve, into the
pulmonary artery and to the lungs where it is oxygenated.
o Oxygen-rich blood circulates.
 The pulmonary vein empties oxygen-rich blood from the lungs into the left atrium of
the heart.
o Opening of the mitral valve.
 As the atrium contracts, blood flows from your left atrium into your left ventricle
through the open mitral valve.
o Prevention of backflow.
 When the ventricle is full, the mitral valve shuts. This prevents blood from flowing
backward into the atrium while the ventricle contracts.
o Blood flow to systemic circulation.
 As the ventricle contracts, blood leaves the heart through the aortic valve, into the
aorta and to the body.